Oddities, musings and news from the health world

Cold-water immersion is best for heatstroke

February 5, 2009 | 1:46
pm

A Kentucky high school football coach was arraigned last month on charges of reckless homicide when a player under his supervision collapsed and died during practice on a hot day last August. The case illustrates the frustration people have over such seemingly senseless heat-related deaths and points to the need for preventing these tragedies.

A review published this week in the Journal of Athletic Training provides needed information on the best way to treat athletes, or anyone working in extreme heat, who suffer heat-related illnesses. The study, an analysis of other research on the condition, concludes that people who are clearly suffering from exercise-induced hyperthermia should be immersed in ice water or cold water as quickly as possible, even before being transported to a hospital. If a place to immerse the person, such as an ice tub, kiddie pool or swimming pool, is not available, the second-best approach is to have a large cooler with ice, water and towels on hand. Cold, wet towels should be placed all over the person's body and changed every two to three minutes. The study found that fanning the person and placing wet towels or ice bags on certain parts of the body and showering the body with water and fanning are not nearly as effective.

"The athlete should be treated first and transported second," the lead author of the study, Brendon McDermott of the University of Connecticut, said in an interview. "The cells are being cooked, and the outcome depends on how long the temperature is elevated." Just placing ice or wet towels on the head, neck or stomach won't bring down the body's core temperature fast enough, he said. "Targeting certain body parts with ice bags is not effective cooling. It feels good. But your core temperature may not be cooling, and internal temperature is the most important thing."

The big problem with applying such life-saving treatment, McDermott said, is that the people on the scene have to make sure the athlete is suffering from a heat-related illness, not cardiac arrest, a diabetic or asthma attack or some other illness. Ideally, he said, certified athletic trainers should be on the scene to make that assessment. Professional teams and most college teams have such individuals at their disposal. But in many states, including California, athletic trainers are not required to be in attendance at practices or games. The governing body of California high school athletics, the California Interscholastic Federation, recommends this practice but does not demand it due to cost issues.

"Heatstroke is not necessarily preventable," McDermott said. "But a fatality from heatstroke can be prevented. These tragic situations need to lead to more positive outcomes in the future."